Adoption Application

Which animal are you applying to adopt? *

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail

Date of Birth *

Month Day Year

How many live in your home? *

Please list the ages of children in your home:

If you rent, what is the pet policy?

Landlord's Name

Landlord's Phone

Area Code Phone Number

Current Pet Information

Past Pet Information

Please describe your knowledge of the care this animal will require *

Describe where your new pet will be living: *

How much do you think your new pet's care will cost each month? *

How will you handle any behavior issues that may arise? *

What reasons might prompt you to consider returning the animal? *

Current Vet's Name

Current Vet's Phone

Area Code Phone Number

Please provide two references:

Name *

Phone Number *

Area Code Phone Number

Name *

Phone Number *

Area Code Phone Number

Thank you for considering adopting from A Critter's Chance!

This section to be filled out by A Critter's Chance Adoption Counselor:

Animal's Chip ID

Date of Adoption

Month Day Year